Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Hally Health Facility/Professional Facility Modifier Low / Median / High Price $150.00 / $150.00 / $150.00	Facility		$150.00	$150.00	$150.00
Medica Facility/Professional Facility Modifier Low / Median / High Price $95.00 / $95.00 / $95.00	Facility		$95.00	$95.00	$95.00
Wellmark Facility/Professional Facility Modifier Low / Median / High Price $45.25 / $18,170.00 / $40,290.00	Facility		$45.25	$18,170.00	$40,290.00